<form action = "index.php" method = "post" name = "loginForm" onsubmit = "return validateRegistrationForm('{$live_path}', this.name)">
<div class = "unocart_register">
  <table>
    <tr>
      <td width = "215">
        {$smarty.const._UNOCART_REG_TITLE} *
      </td>
      <td>
        {$select_titles}
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_USERNAME} *
      </td>
      <td>
        <input type = "text" name = "u_name" id = "u_name" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td width = "215">
        {$smarty.const._UNOCART_F_NAME} *
      </td>
      <td>
        <input type = "text" name = "f_name" id = "f_name" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_L_NAME} *
      </td>
      <td>
        <input type = "text" name = "l_name" id = "l_name" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_FIRMA_NAME}
      </td>
      <td>
        <input type = "text" name = "firma_name" id = "firma_name" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_EMAIL} *
      </td>
      <td>
        <input type = "text" name = "email" id = "email" value = "" class = "inputbox" />
      </td>
    </tr>
  </table>
</div>

<div class = "unocart_register">
  <table>
    <tr>
      <td width = "215">
        {$smarty.const._UNOCART_STREET_NR} *
      </td>
      <td>
        <input type = "text" name = "street" id = "street" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_ZIP} *
      </td>
      <td>
        <input type = "text" name = "zip" id = "zip" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_CITY} *
      </td>
      <td>
        <input type = "text" name = "city" id = "city" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_STATE} *
      </td>
      <td>
        <input type = "text" name = "state" id = "state" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_COUNTRY} *
      </td>
      <td>
        {$select_countries}
      </td>
    </tr>
  </table>
</div>

<div class = "unocart_register">
  <table>
    <tr>
      <td width = "215">
        {$smarty.const._UNOCART_TELEFON} *
      </td>
      <td>
        <input type = "text" name = "phone" id = "phone" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_FAX}
      </td>
      <td>
        <input type = "text" name = "fax" id = "fax" value = "" class = "inputbox" />
      </td>
    </tr>
  </table>
</div>

<div class = "unocart_register">
  <table>
    <tr>
      <td width = "215">
        {$smarty.const._UNOCART_PASSWORD} *
      </td>
      <td>
        <input type = "password" name = "password" id = "password" value = "" class = "inputbox" />
      </td>
    </tr>
    <tr>
      <td>
        {$smarty.const._UNOCART_PASSWORD_2} *
      </td>
      <td>
        <input type = "password" name = "password_2" id = "password_2" value = "" class = "inputbox" />
      </td>
    </tr>
  </table>
</div>
<input type = "hidden" name = "option" value = "com_unocart" />
<input type = "hidden" name = "task" value = "save_register" />
<input type = "hidden" name = "{$validate}" value="1" />
<input type = "hidden" name = "gid" value="0" />
<input type = "hidden" name = "id"  value="0" />
<input type = "submit" name = "" value = "{$smarty.const._UNOCART_SEND_REGISTRATION}" class = "button" />
</form>